Abstract TP060: Evaluation of the Satety Profile of the Tirofiban Protocol for Select Patients with Acute Ischemic Stroke at a United States Comprehensive Stroke Center

Background and Purpose: Tirofiban, a glycoprotein IIb/IIIa receptor inhibitor, has been studied as an adjunctive treatment in patients with acute ischemic stroke. In the recent RESCUE BT2 trial in China, intravenous (IV) tirofiban in patients without medium or large vessel occlusions was associated with an improvement in functional outcomes compared to aspirin monotherapy, though with slightly higher incidence of intracranial hemorrhage. As with many stroke trials, the majority of studies regarding tirofiban were performed in a majority Han Chinese population. This study aims to evaluate the safety, feasibility and efficacy of the administration of tirofiban in RESCUE BT2 eligible patients at a comprehensive stroke center, in the United States. Methods: This single-center retrospective study analyzed the electronic medical records of patients who were treated with tirofiban per RESCUE BT2 protocol, from November 2023 to June 2025. Clinical safety outcomes included 90-day mortality rate, asymptomatic or symptomatic intracranial hemorrhage (sICH) within 48 hours following treatment, tirofiban-induced thrombocytopenia, and extracranial bleeding. Clinical outcomes were assessed using the National Institute of Health Stroke Scale (NIHSS) scores at discharge, and modified Rankin Score (mRS) at discharge and 90 days. Results: A total of 32 patients, with a median NIHSS of 7 at the time of early neurological deterioration received tirofiban, were included. Most patients had either small vessel or large artery atherosclerotic disease. While 3 of the patients who received tirofiban, with 53% (n = 17) of patients receiving preceding antiplatelet therapy, had extracranial bleeding (nasal mucosal and gastrointestinal tract bleeding), none of the patients had ICH (symptomatic or asymptomatic) within 48 hours or tirofiban-induced thrombocytopenia. One patient died but it was not adjudicated to be due to tirofiban. At discharge, the median NIHSS was 5 and the median mRS was 4. The median mRS at 90 days was 3. Conclusion: This study demonstrated that IV tirofiban has a favorable safety profile in patients with recent onset or progression of stroke symptoms and non-occluded medium and large-sized cerebral vessels. We plan to compare it to dual-antiplatelet therapy in the future.